The effect of age on complications in women undergoing minimally invasive sacral colpopexy.

INTRODUCTION AND HYPOTHESIS: Previous research has demonstrated similar complication rates in older and younger women undergoing abdominal sacral colpopexy via laparotomy. The objective of this study was to compare perioperative complications in older and younger women undergoing minimally invasive sacral colpopexy. METHODS: This was a retrospective study of laparoscopic and robotic sacral colpopexies performed from January 2009 to May 2012 at a large academic center. Patient demographics, surgical data, and perioperative complications were compared in women < 65 and ≥65 years of age. Primary outcome was the difference in major complications. RESULTS: A total of 302 women underwent minimally invasive sacral colpopexy during the study period. Mean age was 58.5 ± 8.8 years and 84 subjects (27.8 %) were ≥65 years. Older women were more likely to have had a prior hysterectomy (60.7 vs 39.0 %, p = 0.001) and had more severe preoperative prolapse (86.9 % vs 71.9 % ≥ POPQ stage III, p = 0.01). There was no significant difference in duration of hospitalization (1.4 vs 1.4 days, p = 0.54). Overall, there were significantly more major complications in women ≥ 65 years (unadjusted OR 1.84, 95 % CI 1.02-3.35, p = 0.04). After controlling for BMI, route of surgery, estimated blood loss (EBL), and operating room time, age ≥ 65 remained a significant predictor of complications (adjusted OR 2.28, 95 % CI 1.21-4.29, p = 0.01). CONCLUSIONS: Our findings suggest that older women have a higher rate of major complications following minimally invasive sacral colpopexy, even after controlling for BMI, route of surgery, EBL, and operating room time. This increased risk should be addressed during preoperative counseling and may influence surgical planning.

Dispelling the myths of CPR.

Without a "do not attempt resuscitation" order on a patient's chart, nurses are obliged to initiate cardiopulmonary resuscitation (CPR) on all patients who die in hospital. Their discomfort with this situation is often related to the perception that resuscitation attempts are being carried out, at best, inappropriately and, at worst, unethically.

A neural shift theory of migraine.

Migraine headache may lend itself to epidemiological inquiry that includes disruptive serotonergic psychosocial behaviors. To advance our knowledge of the etiology of this neurologic disorder, measurable psychosocial behaviors that are correlated with variability in monoamine neurotransmission need to be examined in the migraine population in a controlled fashion. It may be that those with migraine have a more difficult time adapting to internal or external environmental changes based on a different distribution of serotonin levels or activity. Psychosocial behaviors are outlined as possible serotonin indicator variables for future migraine investigation.

Finger movement is associated with attenuated cutaneous reflexes recorded from human first dorsal interosseous muscle.

Cutaneomuscular reflexes (CMR) have been recorded from the first dorsal interosseous muscle (1DI) of the preferred hand, somatosensory evoked potentials (SEP) were recorded from the contralateral sensory cortex and the sensory nerve action potential (SNAP) was recorded from the median nerve of 15 adult subjects whilst electrically stimulating the digital nerves of the index finger. Subjects performed the following tasks (a) a sustained abduction of the index finger against resistance at 10-20 % maximum voluntary contraction (MVC), and (b) abduction of the index finger as in (a) whilst performing self paced low amplitude tapping of the (i) index finger, (ii) thumb, (iii) middle finger, (iv) little finger and (v) ipsilateral foot. The E2 component of the CMR and the N20/P25 components of the SEP were significantly reduced during finger tapping (P < 0.05). This reduction was independent of which finger was tapping (P > 0.05). There was a significant (qualitative) relationship between the decrease in the size of the E2 component of the CMR and the N20/P25 components of the SEP ((2) test; P < 0.05). There were no significant changes in E1 and I1 (P > 0.05). The size of the SNAP was independent of task (P > 0.05). The size of the E1, I1, E2 components of the CMR, and the N20/P25 components of the SEP were unaltered during foot tapping (P > 0.05, n = 4). We conclude that the decrease in size of the E2 component associated with finger tapping results from gating of the digital nerve input.

How SCUs (specialty care units) help residents with mental health problems.

Do elderly persons with mental health problems respond better to care in segregated or integrated environments? To find out, the Manitoba government constructed two, ten-bed specialty care units for residents with behavior problems.

Parent to parent: preventing adolescent exposure to HIV.

A 2-year pilot program implemented by public health nurses (PHNs) in partnership with the leaders of parent associations of 10 urban high schools encouraged communication about health-promoting sexual behavior between adults and adolescents. The purpose was to assess the feasibility of involving parents in health promotion efforts in schools. During the first year, PHNs prepared a cohort of 17 parent trainers to make presentations to parent groups about the reality of teens' risk for human immunodeficiency virus (HIV) exposure, facts to counter myths about outcomes of sex education, and the skills teens need to implement healthy choices, including abstinence, correct condom use, and talking about sex with a potential sexual partner. Each parent trainer was then scheduled to make two presentations at parent association meetings. Criteria for assessing the impact of extending the program, including broader diffusion in the community, are proposed. This approach may be effective for community-based education about other health issues.

Migraine trigger factors in non-clinical Mexican-American population in San Diego county: implications for etiology.

We conducted an investigation of migraine headache in a general population of Mexican-Americans living in San Diego county. Specific headache triggers were reported and analyzed, the most frequently reported for females with migraine being missing meals (58.9%), weather changes (54.4%), menstruation (53.6%), post-crisis letdown (52.7%), and fatigue (51.8%). The most frequently reported trigger factors for migraines reported by males were fatigue (58.8%), sleep (as a precipitating factor) (56.3%), post-crisis letdown (41.2%), and weather changes (37.5%). Trigger factors were further evaluated using stratification by presence or absence of Raynaud's phenomenon (RP), menstrual migraine, family history of migraine, and by migraine type. Odds ratios and 95% confidence intervals were calculated. These results suggest that subjects with migraine and RP (perhaps indicative of a systematic vascular tone disorder) and those with menstrual migraine (indicative of sensitivity to hormonal changes) may overall be more sensitive to certain environmental stimuli, particularly those involving change in the internal environment.